Provider Demographics
NPI:1649292046
Name:MOULTON, ANDREW WELLS (MD)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:WELLS
Last Name:MOULTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2730 N MCMULLEN BOOTH RD STE 202
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-3302
Mailing Address - Country:US
Mailing Address - Phone:727-580-7747
Mailing Address - Fax:727-245-8879
Practice Address - Street 1:2730 N MCMULLEN BOOTH RD STE 202
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-3302
Practice Address - Country:US
Practice Address - Phone:727-474-7411
Practice Address - Fax:833-974-2140
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME96175207X00000X, 207XS0117X
NY223687207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI02395Medicare UPIN
FLGW903ZMedicare UPIN
NY567F81Medicare PIN